This course will critically explore the fundamental drivers of health that arise from social conditions. Situated at the intersection of social, behavioral and life sciences, course material will interrogate the myriad ways in which culture, race/ethnicity, gender, poverty, and sexual orientation shape health outcomes and drive health disparities. Together, we will reflect on the extent to which social conditions contribute to ill-health and on the ways these social factors “get under the skin” to produce and maintain disease. As a theoretical foundation for the course, readings will introduce key conceptual frameworks and theories underpinning the social determinants of health, including ecological systems theories and Link and Phelan’s seminal work on “fundamental causes.” Afterwards, plausible mechanisms underlying health disparities will be presented. This will pave the way for focused discussions of the relationship between each of five social factors, namely socioeconomic status, gender, sexual orientation, race/ethnicity, immigration/displacement, and health.Below is a more thorough outline of the 10 week journey exploring the social determinants of health.

Week 1: Key conceptual frameworks and mechanisms underlying the social determinants of health

We will discuss causal inference. What are Mill's criteria for causality and how have they shaped thinking around causes?

Readings will introduce the “population approach” to health etiology and intervention

Together, we will explore key conceptual theories such as the fundamental causes (FC) framework to health inequalities and pathways by which social factors “get under the skin"

Week 2 and 3: Social class, socioeconomic status, and the social gradient in health

• What is social stratification? What are the different sociological traditions that have impacted the understanding and measurement of social class (ex Weberian, Marxian, and functionalist traditions)? What are the shortcomings of these traditions?• What are existing measures of social stratification? What are their strengths and weaknesses?• What studies have been conducted to interrogate the impact of social stratification on the health of populations? What are the limitations and strengths of these studies?• We will survey the evidence around social inequalities and health. What evidence is there and what exactly is the social gradient in health? Is this evidence compelling or are there alternative explanations that can explain this association?• • What are practical policy and programmatic interventions that could be effective in reducing disparities rooted in social status

Week 4: Race, Racism, and Discrimination

• Critically evaluate “race” as a social construct and contemplate the following question: Is racism ontologically subjective? Is the construction of race contingent on collective acceptance? How has the meaning of race developed historically?• Examine levels of racism (structural/systemic/institutional, interpersonal, and individual). How does racism manifest on different levels; on the structural, interpersonal and individual levels?• What are types of racism/discrimination – aversive racism, internalized racism and stereotype threat? Are these real phenomena? What are your critical opinions of these terms?

Week 5: Race, Racism, and Discrimination

• We will discuss measurement and other methodological issues in the study of racism and health. How have sociologists attempted to measure the prevalence of racism? What are the merits of various working definitions and measurements of racism and what are their weaknesses? Do these definitions measure what they are supposed to measure?• How can we address the insidious impact of racial discrimination on health? What kinds of policies and interventions can mitigate the impact of racial discrimination on health?

Week 6: Immigration/displacement and Health• We will be introduced to and asked to problematize the construct of acculturation• What are the key elements of the “new sociology of immigration”?• What are the features of immigrant and ethnic health paradoxes?• We will examine the processes of racialization and their relevance for immigrant health trajectories• We will explore the influence of ethnic identity and ethnic enclaves on immigrant health• Case studies will be explored to showcase the impact of acculturation on health with emphasis on migration and health in the Arab World and how migrant communities have been affected by the habits and behaviors of the host community.

Week 7: Gender and Health

• To start, we will problematize the interchangeability of the terms “sex” and “gender”. How are these concepts different and how do they intersect? Is the distinction warranted?• We will discuss core gender concepts, particularly concepts such as ‘binary’, ‘essentialism’ , ‘patriarchy’, ‘hegemony’ ‘gender normativity’ and ‘social construction’ which are often used in the literature on gender. What is meant by these terms and what are competing views about these constructs? Are these constructs rooted in Western schools of thought or do they have a basis in other cultures?• What are paradoxes and deviations in assumptions about gender and health – does male privilege translate into unambiguous health benefits?• What is the empirical patterning in morbidity and mortality by gender• We will not forget to include masculinities in our discussions. We will explore the relevance of gender to men and theories of masculinity

Week 8: Gender and Health

• First we will define “intersectionality” and elaborate on its potential contribution to understanding the impact of gender and other axes of stratification on health outcomes• What are types of sexism: ambivalent sexism, hostile and benevolent sexism? You will be asked to reflect on these terms and their utility in understanding the different manifestations of sexism.• What is system justification and how is it used to justify the existing social order? To what extent is this applicable to the context of Egypt? What evidence do advocates of system justification provide for its presence? What are the critiques against it?• What are methodological and measurement issues in the study of gender? What is wrong with the way studies look at gender?

Week 9: Sexual Orientation and Health

• Readings will deconstruct sexual orientation along three axes: sexual attraction, self-identification, and sexual behavior. Is this deconstruction useful? How can we unpack and operationalize sexual orientation? How can we measure its prevalence?• ?• What is the evidence for sexual orientation health disparities? Mental Health, HIV and suicidality disparities• Explicate how the health implications of sexual orientation are shaped by social context and stigma• Discuss transgender health and explore case studies on the history of hijras in South Asia, kathoeys in Thailand, and muxes in Mexico. How have societies viewed transgender populations across history in the East and West? What implications have these perceptions had on the health of these populations?

Week 10: Culmination

• Summarize cross-cutting themes – social context, stigma, and stress• How do we alter the social environment to improve health outcomes?• Food for thought: are social inequalities inherent and unavoidable?

In a nutshellThe social environment plays a pivotal role in shaping our health and well-being. Although, historically, the medical field has focused on proximate determinants of health and biological risk factors, there is growing recognition of the importance of fundamental social causes in defining health trajectories. An understanding of the inextricable link between social conditions and health can help inform and inspire effective interventions to address health inequities

Why take this course?Not all health inequalities are unjust. Take for example differences in women’s and men’s health: breast cancer is more prevalent among women than men. Such disparity is unavoidable and is due to biological factors. In cases where differences in health outcomes however occur due to social conditions – such as increased mortality rates among the poor because of poverty – that is when disparities are morally offensive because they are unnecessary, unjust and avoidable. If you are interested in social theory, social justice and public health, then this should be a great place to start!

Shatha Elnakib earned her Masters in Public Health from Columbia University. She is a researcher and practitioner working at the intersection of sexual, reproductive and migrant health. Shatha’s research interests are inspired by questions of health equity and reproductive justice. She has experience working with UN and international NGOs such as UNICEF, UNFPA, and the Population Council. Currently, she works for UNFPA Egypt as the humanitarian focal point where she coordinates sexual and reproductive health projects and interventions among refugees. ​